Behavioral treatment of bedtime problems and night wakings in infants and young children

Department of Psychology, Saint Joseph's University, 5600 City Avenue, Philadelphia, PA 19131, USA.
Sleep (Impact Factor: 5.06). 11/2006; 29(10):1263-76.
Source: PubMed

ABSTRACT This paper reviews the evidence regarding the efficacy of behavioral treatments for bedtime problems and night wakings in young children. It is based on a review of 52 treatment studies by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on behavioral treatments for the clinical management of bedtime problems and night wakings in young children. The findings indicate that behavioral therapies produce reliable and durable changes. Across all studies, 94% report that behavioral interventions were efficacious, with over 80% of children treated demonstrating clinically significant improvement that was maintained for 3 to 6 months. In particular, empirical evidence from controlled group studies utilizing Sackett criteria for evidence-based treatment provides strong support for unmodified extinction and preventive parent education. In addition, support is provided for graduated extinction, bedtime fading/positive routines, and scheduled awakenings. Additional research is needed to examine delivery methods of treatment, longer-term efficacy, and the role of pharmacological agents. Furthermore, pediatric sleep researchers are strongly encouraged to develop standardized diagnostic criteria and more objective measures, and to come to a consensus on critical outcome variables.

Download full-text


Available from: Brett R Kuhn, Jul 26, 2015
1 Follower
  • Source
    • "An experimental study examining nap deprivation in 30-36 month old children found less effective emotion regulation in sleep-restricted preschoolers [27]. Additionally, studies demonstrating improvements in family and child functioning following behavioural sleep intervention suggest that poor child sleep is at least partially causal [4]. On a societal level, childhood sleep problems are associated with additional healthcare costs [28]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Night wakings and bedtime problems in infants and young children are prevalent, persistent, and associated with a variety of impairments in youth and their families. Assessment strategies include clinical interview, sleep diaries, actigraphy, and subjective measures. A number of treatment approaches with varying degrees of empirical support are available, and several novel strategies have been evaluated in recent years. Appropriate sleep scheduling and a bedtime routine are important components of any treatment program.
    Paediatric respiratory reviews 04/2014; 15(4). DOI:10.1016/j.prrv.2014.04.011 · 2.22 Impact Factor
  • Source
    • "Today, as a result, public health messages often advocate behavioural interventions for infant feeds and sleep in the first weeks and months. However, studies cited as evidence that behavioural interventions in the first three to four months of life prevent or improve cry-fuss problems, improve maternal sleep duration, and improve behaviour and sleep in later childhood extrapolate data derived from older infants and their families back to the first few months of life [15] [37]. These studies do not integrate the evidence that overly frequent or prolonged breastfeeding and excessive waking signal an underlying problem of poor milk transfer, caused by various feeding problems which require appropriate assessment and management, not feed spacing [38] [39] [40]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although problem crying in the first three to four months of life is usually self-limiting, it is not a trivial condition. Early intervention is important, yet families receive conflicting advice from health professionals. The past decade has seen significant advances in neuroscience, lactation science, and developmental psychology, including new insights into the significance of developmentally sensitive windows. We propose a neurobiological model to explain the mechanisms of cry-fuss problems in the first months of life, and the mechanisms which underlie effective intervention, with a view to facilitating research collaboration and consistency of advice across health disciplines. We hypothesise that crying in the first three to four neurodevelopmentally sensitive months signals activation of the hypothalamic-pituitary-adrenal axis and adrenergic neuronal circuitry in response to perceptions of discomfort or threat. Susceptible infants may be conditioned by early stress, for example, by unidentified feeding difficulties, into a sensitised stress response, which usually settles at three to four months of age with neurodevelopmental maturity. Bouts of prolonged and unsoothable crying result from positive feedback loops in the hypothalamic-pituitary-adrenal and adrenergic systems. Importantly, epigenetic modulation of the infant's limbic neuronal circuitry may explain correlations between regulatory problems in the first months of life, and behavioural problems including feeding problems in later childhood.
    Medical Hypotheses 09/2013; 81(5). DOI:10.1016/j.mehy.2013.09.004 · 1.07 Impact Factor
  • Source
    • "Sleep problems during infancy are associated with overweight or obese children (Bell and Zimmerman, 2010; Taveras et al., 2008), behavior and emotional problems (Minde et al., 1993; Lam et al., 2003), poor language development (Dionne et al., 2011), and parental distress, mood and sleep disturbances (Armstrong et al., 1998; Martin et al., 2007; Thome and Skuladottir, 2005; Sinai and Tikotzky, 2012). Although diagnostic criteria and behavioral treatment options for infant sleep problems do exist (American Academy of Sleep Medicine, 2005; Mindell et al., 2006; Ramchandani et al., 2000; Nikolopoulou and St James-Roberts, 2003), most sleep studies do not use specific clinical definitions but rely on parental reports of sleep problems in their child. Very little is known about how first-time mothers perceive infant sleep problems and how they cope with the problem when sleep patterns are still developing and erratic sleep patterns may be considered normal during the first three months of life. "
    [Show abstract] [Hide abstract]
    ABSTRACT: to describe the aspects of infant sleep perceived as problematic by first-time Taiwanese mothers and to discover how mothers cope in response to infant sleep concerns. a qualitative approach was used for data collection. in-depth interviews were conducted and audio-taped at mothers' homes. 12 first-time mothers within three months post partum. content analysis was performed to identify patterns, similarities, and differences in the individual and collective interview data. The major themes describing maternal coping experiences were 'self-help' and 'seek-help.' Self-help coping efforts included reception and acceptance of suggestions as well as changing behaviour to allow mothers to feel capable of adapting to infant sleep patterns or problems. Seek-help was a later stage of coping for mothers when they actively utilised formal and informal sources of help to identify and manage infant sleep problems. The majority of mothers sought informal help sources from family members, friends, or online information. Mothers who suspected their infant of suffering from sleep problems either delayed seeking medical advice or did not actively consult a health care provider. nurses and health care providers who work in antenatal, postnatal, and paediatric clinics should actively educate and provide information about infant sleep patterns and sleep management options to first-time mothers and discuss maternal coping strategies.
    Midwifery 08/2013; 30(6). DOI:10.1016/j.midw.2013.08.005 · 1.71 Impact Factor
Show more